March 23, 2023

In "A Tough Two Weeks," Dr. Osterholm shares why the past two weeks have been among the most challenging of the pandemic for him. He also provides an update on global and national COVID trends, examines the latest data on the possible source of the pandemic, and answers a COVID query on booster shots following COVID infection.

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Chris Dall: [00:00:06] Hello and welcome to the Osterholm Update: COVID 19, a podcast on the COVID 19 pandemic with Dr. Michael Osterholm. Dr. Osterholm is an internationally recognized medical detective and director of the Center for Infectious Disease Research and Policy, or CIDRAP at the University of Minnesota. In this podcast, Dr. Osterholm will draw on more than 45 years of experience investigating infectious disease outbreaks to provide straight talk on the COVID 19 pandemic. I'm Chris Dahl, reporter for CIDRAP News, and I'm your host for these conversations. Welcome back, everyone, to another episode of the Osterholm Update podcast. It was just around three years ago that Americans were just starting to see the first signs of how COVID 19 would turn our lives upside down. On March 13th, 2020, the Trump administration declared a nationwide emergency and issued a travel ban on non-US citizens traveling from Europe. On March 15th, the New York City public school system shut down. On March 19th, California Governor Gavin Newsom issued a stay at home order for state residents. Those days and the pervasive fear and uncertainty that we were living with are in the past. But COVID 19 is still with us, and we continue to feel its impact and we're still grappling with what we've learned from this experience and how those lessons might help us in future pandemics. That will be the focus of this March 23rd episode of the Osterholm Update podcast. We'll also provide an update on the current COVID trends here in the US and around the world. Examine the newest revelations and data on the possible source of the pandemic. Discuss the latest developments in the controversy over the Cochrane Review on masking, and answer a COVID query about booster shots following infection. We'll also share a beautiful place from one of our listeners. But before we get started, as always, we'll begin with Dr. Osterholm's opening comments and dedication. And Mike, you also have some news you want to share with our listeners.


Dr. Osterholm: [00:02:09] Thanks, Chris, and welcome back to all of the podcast family to another update. I think today will be one of the more unusual ones for you is what I'm about to talk about. And for those who might be coming for the first time to the podcast, as I say, each week, I hope that we are able to provide you with the kind of information that you find useful and helpful. And surely we will do our best to explain what we know and what we don't know. And far too often what we don't know does take up a fair amount of time. Today I'd like to dedicate this podcast to someone who we've dedicated it to before, but it's that someone that I think we can never probably dedicate it to Enough. And it surely has something that has come to mean everything to me and is part of the reason, as you'll see in a moment, why I'm doing this podcast today. It's all about friends. You know, we can never, ever overstate the importance of friends. Now they can be family, but often they're not. They don't have to be there for us because they were not by birth somehow tied to us. They don't have to be there with us because they work with us, but they could be friends at work with us. But they're often just friends, people who care, people who share. People understand people who don't even have to understand but be there. And I think throughout this pandemic, I think time and time again, how often friends have been so critical.


Dr. Osterholm: [00:03:39] And what we think about how we think about it, what we're afraid of, what we feel comfort in. Who is it that's there during our lonely hours? Who's not? And think if any one thing has come through in this podcast, family experience has been we're not just partners in a podcast. We're friends. And I cannot begin to tell you how much that means to me. And in particular right now, a more in a moment. But before I go into that, let me just remind you that there's very good news that I would say in quotes on the horizon today, March 23rd. The first podcast after the spring solstice and for which we are celebrating sunlight today. Sunrise in Minneapolis is at 7:10 a.m. Sunset is at 7:29 p.m. That's 12 hours, 18 minutes and 19 seconds of sunlight. And that, of course, doesn't even include Twilight, which many of you know all about. We are gaining the most sunlight per day at any time in the year at three minutes and nine seconds a day. Just a few short days that will start going back down, Even though it will be a positive increase, the rate of increase will go down until June 21st. And I just want to say, this is a wonderful time of the year, even here in Minneapolis, where it still is yet cold, still have snow. That sunlight is so powerful. It's not just the fact that it's sunlight.


Dr. Osterholm: [00:05:03] It's something that does to us that is so important. And I also want to acknowledge that this is that one time in the year where we can feel equally good about sharing the sunlight discussion with our dearest friends and colleagues at the Occidental Belgium Beer ouse in Auckland. As many of you know, this is one of my most favorite places in the whole world. To be on Vulcan Lane at the Occidental Today in Auckland they will have 12 hours and three minutes and seven seconds of sunlight with sunrise at 725, sunset at 728. They are unfortunately losing two minutes and 21 seconds of sunlight a day, but we're about the same right now so we can share with each other the beauty of the sunlight. So with that, let me now move to the part of the introduction here that I don't know how I'm going to do it. I have not rehearsed this. I have not really given it probably all the thought I should, but I've given it a lot of thought. On March 10th, a week ago last Friday, we had a wonderful evening at our home. It was my 70th birthday. Fern and I were celebrating dinner together with one of our dearest friends from CIDRAP. We did the Osterholm protocol as it's become known. We had no known exposures to anyone in the five previous days that had COVID. We had no symptoms whatsoever, not even a sniffle. And we all tested negative.


Dr. Osterholm: [00:06:25] We enjoyed the time here for dinner. And then we went to a small music venue here in the Twin Cities area. All of us, with our N95s on me, with my face fitted N95. And we went down our elevator in our condo building here. No one around. We were in the elevator, as was been timed about 27 seconds, got in our car, got to the venue, put our N95s on before we walked in. We're there for an hour and 45 minutes in a large room with very few people. It was a small venue but yet separated. We then left the venue, took our N95s off when we actually got to the car. Well, then Saturday night, the 11th, we had four guests over to our condo for dinner. Same Osterholm protocol. In fact, also the third person that was with us, the one on Friday night, also had entertained someone on Saturday night at their place. And we had wonderful, enjoyable evenings that Saturday night on the 11th, we were together for almost 4.5 hours, and it was just magic for my soul. Well, Sunday afternoon, all three of us who were there on Friday night started to feel ill. The kind of classic early onset symptoms you think of with COVID started to develop upper respiratory symptoms, just feeling very tired, sluggish, feeling, some tightness in my chest. And we all tested negative Sunday night. The 11th symptoms continued to worsen for all three of us. Again, onsets were very similar in time and by Monday morning we still were testing negative.


Dr. Osterholm: [00:08:01] But that afternoon one of us tested positive and shortly thereafter all three of us did. We had COVID. I finally, after three years of doing everything I could to prevent becoming infected with this virus, I did. Now, when I look back on it, I do not have an explanation for how I got it. The people who were with us on Saturday night, none of them got infected. It was clear that, in fact, had we been infectious on Friday night, we surely would have infected them on Saturday night. Between the three of us, we had 15 doses of vaccine, five each. We were in 95. The only possible exposure I can think of was, in fact, in that elevator. But there was no one around 27 seconds from door opening to door, closing to door, opening, door closing. And it just would have to be a very, very high infectious dose with even 5 to 6 inhalations that would have occurred during that time. I tell you this, first of all, to say, for those who have gotten infected before, I now understand what it feels like, where you're asking yourself, what did I do? How did I do this? What's wrong? And you didn't fail. You didn't fail then. I didn't fail. And yet I know that I feel with this virus that somehow I should have done something better, something different. I still believe strongly in the protection of the N95 respirator as appropriately worn.


Dr. Osterholm: [00:09:30] But I can't explain my illness today as I speak to you now, some almost 11 days after onset and five days of Paxlovid treatment. I'm beginning to realize I'm probably starting to experience a rebound. I was much better than the last several days. Today I feel like I got hit by a train. Upper respiratory symptoms are beginning again. I feel the fatigue that is marked and that many of you already know all about. You may ask, why am I doing this podcast? Because I wouldn't miss this. I have said time and time again, I think I and the team members who put this podcast on actually get much more out of this than maybe you get from us. You are such a gift to us. And so I'd have to be on my deathbed not to record this podcast, but today I record it with some very mixed feelings. First of all, physically not feeling that well. Second of all, what did I do? What could I have done differently? And third of all, remaining committed to those who are not yet infected, who have underlying health conditions, who are older, do not feel like somehow you can and must surrender. But it's a challenge. It's a challenge. And I'm an example of that challenge right now. So I'm still trying to figure out, you know, what's going to happen to me over the course of the next few days. I do know that, you know, having taken the Paxlovid, I felt confident that I would not get seriously ill.


Dr. Osterholm: [00:11:02] I'm very relieved by the ever increasing data showing that the frequency of long COVID with persons infected with the Omicron Subvariants is substantially lower than the incidence of long COVID among those who are infected with Alpha and Delta earlier in the pandemic. But the bottom line is I'm infected and it is a challenge. Second of all is the fact that I am more committed than I've ever been committed to helping those who are at increased risk for serious illness, hospitalizations and deaths that don't give up, don't give up. You can keep from getting infected. I do feel like I probably ought to turn in my epidemiology union card right now if I can't even figure out my own illness, who am I as an epidemiologist? I mean, this is really a challenge for me. You know, I've been fortunate to be involved with some very, very complicated outbreaks over the course of my career that we ended up solving, you know, the whodunit. And I can't even solve my own exposure to this virus. What's wrong with me? So anyway, I will leave it at that just to say that I'm here. If you get some scratchiness in my voice, if you hear a few sniffles, you are hearing. Right. That's where I'm at right now. But I would not miss this podcast opportunity. I think right now I need you all probably a lot more than you need me.


Chris Dall: [00:12:24] Well, Mike, I'm sure our listeners join me in wishing you and Fern a speedy recovery. Now on to the business of the podcast. Let's take a quick look at the international COVID situation. Is there anything noteworthy that you're seeing globally?


Dr. Osterholm: [00:12:41] Well, Chris, the one thing that I see that is notable is that without regard to what's actually happening with the virus, we are not only accepting the fact that the pandemic is behind us. And as you know, I have said in repeated occasions, I won't no, the pandemic is over probably until a year out for which we actually see the lack of sustained major transmission. I don't know where we're at in the pandemic, but I can surely say we're in a much better place. One of the real challenges we have right now is we are dismantling all of the surveillance systems, all the places that collected numbers, that basically attempted to give us some sense of what was going on with COVID. And today, without that, it's very hard to know what is happening in much of the world. For example, as of March 10th, the Johns Hopkins Global Coronavirus Dashboard no longer collects and reports international COVID data. Since the Johns Hopkins Dashboard was a primary source for many other COVID dashboards showing international data, including The New York Times, the Washington Post, the Kaiser Family Foundation, etcetera. Now, we really don't have that information anymore. And so at this point, we're now using the Who's COVID dashboard as the only real indication for which we know that there are some challenges with that. For example, even just recently, the dashboard has shifted from daily reporting to weekly reporting as of the end of February.


Dr. Osterholm: [00:14:12] With each update now happening on Wednesdays. So by that following day, we're looking at numbers reported six days prior. For example, the latest complete numbers we have as of today is for the week of March 6th to 12th. So I think at this point we've got to stop comparing numbers as such and to understand that, yes, case numbers are reduced around the world and deaths and hospitalizations are even still challenging in terms of what's going on. For example, let me just look at what's happened with the US compared to the W.H.O. data that I just referred to. If you look at the March 6th to 12th Data for W.H.O., there have actually been 5048 deaths reported for this week, 5048. Now, this is a lot better than it's been when it was, you know, in the tens of thousands of deaths just months ago. But if you actually look at the US numbers, there was 1887 deaths reported during that same time period, 1887 compared to the 5048. That means 37% of all the deaths reported for last week came from the United States. Well, I know that's not the case. That is not the case. And I can go through continent by continent and look at this where the US compared to others and you would see that the rest of the world is just very incomplete reporting.


Dr. Osterholm: [00:15:41] And so from that standpoint, I don't know how to compare what's going on internationally, even if we use deaths. And it's notable, if you just look at Africa alone, Africa has 47 member states in the region. Africa 1.4 billion people. That's 18% of the global population. And for March 6th to 12th, they reported a single death that week in Africa. A single death with 18% of the global population. I know that's not right. So I think at this point, Chris, unless we see major new surges taking off anywhere in the world where there is a substantial increase in hospitalizations and deaths, I think we're going to be basically left to saying the pandemic's in our rear view mirror. I don't know what's happening right now. I think even in this country, which we'll talk about in a moment, reporting is quite incomplete, but it's a lot better than most places in the world. And it's absolutely not the case where 37% of the deaths in this world right now are occurring in the United States. This is an artifact of reporting. And even with our underreporting of deaths, you can agree, I think that there's a lot more going on around the world we just don't know about.


Chris Dall: [00:16:57] Here in the US, around 22,000 new daily cases are being reported. Hospitalizations are the lowest they've been since last May, and test positivity has also fallen sharply in the last few weeks. This all according to tracking by the New York Times. Even deaths appear to be dropping a bit, though they're still hovering around 300 a day. So, Mike, given all that you've said about how people have moved on and the lack of reporting. What's your sense of what's going on in the US?


Dr. Osterholm: [00:17:28] Well, without any doubt, based on my previous answer, it's deja vu all over again. We surely have incomplete reporting here in the United States. The three people who I just talked about who got infected some time on March 10th. All were confirmed by lateral flow testing at home. None of the three of us had our cases reported. And so right there, I'm a personal number this week of unreported cases of COVID. Now, I do think that the hospitalization data and the number of deaths in the United States is still among the best in the world. But as you pointed out, right now, the numbers are coming down. And I think this is really a very positive thing. So, you know, I've said time and time again, you know, I don't want to ever get COVID. Well, I got it. Well, my next best hope is then I don't get seriously ill. And so far I haven't. Even if I'm experiencing a rebound right now, I'm far from seriously ill. I think we're going to see more and more evidence of transmission of this virus in the public for which people are not hospitalized or die, which is good, good news. And we'll talk more about that when we get to vaccines. If we try to find other ways of looking at this surveillance situation, the wastewater data does remain probably our best example.


Dr. Osterholm: [00:18:51] And for the past week, 50% of the sites throughout the United States actually saw reduction in the wastewater levels of COVID 19 virus. 7% were stable and 43% had some increased levels. But even where those increased levels occur, there were no obvious regional differences or nothing that would suggest that there was now a new surge of cases. So I think we're now in the long, long end days of this pandemic, which should be good news for everyone, but it doesn't mean we're over with and done. And so at this point, I think as we look at where we're going, I suspect, Chris, that in future podcasts, when I'm asked this very same question, you're probably going to get a very similar answer. There is surely activity out there. It's still happening. Fortunately, it's fewer numbers of people who are becoming seriously ill and dying. But let me just make note that yesterday in the United States, following what data The New York Times has from the CDC, there was still 22,522 people hospitalized with COVID 283 were in ICUs and 283 died on the seven day moving average. So those are still significant numbers, but it's getting better. I will obviously feel more comfortable if we can see the next 6 to 12 weeks with these numbers continuing to drop, particularly in hospitalizations and deaths, then we'll know that we're there.


Dr. Osterholm: [00:20:18] I leave you with one last caveat, though, and this is not a get out of jail card as much as it's just a reality of where we've been and where we may be going. We still don't know what this virus is going to do over time in terms of any potential new variants or subvariants. We don't yet understand what happens with immunity over time. I'm an example of that. You know, after five doses of vaccine in three years, you know, it was a challenge that, you know, I became infected and clinically ill. Well, I was at almost seven and a half months out from my previous booster dose. Did that play a role in me getting infected this time? What if I had been exposed to this virus in a similar manner but four months before? Would I have gotten clinically? I don't know. So we're going to have to keep that in mind, trying to understand what the future looks like. But in many ways, I think we're almost in the best place we've been in this pandemic since the beginning. And I say almost because again, without more firm numbers, I can't say for certain, but I'm confident that we're really moving in the right direction.


Chris Dall: [00:21:28] Mike. Last week, a French research team told media outlets that they had stumbled upon genetic sequence data posted to a virus sharing database and subsequently taken down by Chinese researchers. The WHO then confirmed that it was made aware of the sequence data in early March. The data, which was analyzed before it was taken down, could add more evidence that the COVID 19 pandemic was zoonotic in origin. What do you make of this latest development?


Dr. Osterholm: [00:21:58] Well, Chris, as you pointed out, there have been a lot of media attention on the origins of COVID 19 in the last several weeks, starting with the Energy Department report on the lab leak theory and our latest episode. As you may recall, I called that political theater in that there was really not additional substantial information to support their low confidence claim that it was a lab leak. I still stand behind that. I don't think the origin of this pandemic will ever be solved. Most people's satisfaction, and I emphasize that because I welcome new information that might come forward. But I don't see a smoking gun ever being found at this point. Now, you can say we were surprised by what came out from the Chinese government several weeks ago and was posted on a website that keeps track of the genetic sequences of the virus or any other sources of genetic sequencing that occurs. And so at this point, it's clear to say that again, there is more information which surely does support the possibility that this was a actual natural spillover event in the Wuhan fish market. Now, let me be really clear, though, that as much as we want to keep talking about this, and I understand why and I surely do not want to diminish that it does nothing to help us get better prepared for the future. That's where I keep coming back to.


Dr. Osterholm: [00:23:24] You know, in a sense, while this is an important understanding to have what happened, we don't need to understand it to know that we have to do so much more to, number one, better prepare ourselves to respond to natural spillover events when they occur in nature. And just look what's happening in Africa right now. We're seeing multiple spillovers of Marburg virus in parts of Africa we've not seen before. Now, fortunately, those viruses are really associated with body fluid contact, not a virus with wings, like you might say. The COVID virus is. But at the same time, it just reminds us these spillover events continue to happen. And if one of them happens to be a viral respiratory pathogen, as I call a virus with wings, then this is a whole new ball game. That's what we need to be preparing for. We also have to be mindful of the proliferation of all these new high containment laboratories around the world and the possibility that people may actually be working in laboratories that don't even have high containment capacity with viruses that if they were to get out, could be a problem. We have to address that, too. So to me, what I worry about is we're going to spend so much time arguing about who said what, about what and what data is there. How good is it that we're going to continue to miss the mark on becoming better prepared? But let me just for the sake of this discussion, dive into the details of what actually happened here and what was reported this past week, you know, following the shutdown of the animal market in Wuhan that was suspected to be ground zero of the pandemic.


Dr. Osterholm: [00:25:03] Samples were taken from surfaces throughout the market. Samples were tested for COVID 19, and those that came back positive were then tested for genetic material belonging to animals, many of them which were a match for raccoon dogs, raccoon dogs or members of the dog family and most closely related to foxes. While their markings make them look like raccoons, they're actually not related to them. They are native to East Asia and are often farmed for their fur, and they're known to be vulnerable to the coronavirus infections. So let's go back to the market and I'll state this again. It's an important detail. The areas of the Huanan seafood wholesale market that tested positive for COVID 19 were the same areas where raccoon dogs were being sold. This meant that the raccoon dogs may have been a part of the jump from wild animals to humans. But let me be very clear. This does not provide conclusive evidence of proof that the raccoon dogs were infected and transmitted the virus to humans.


Dr. Osterholm: [00:25:59] It just provides further evidence that the raccoon dogs, which again are susceptible to the coronaviruses, were in fact present in the market. The fact that Chinese authorities previously denied and could have potentially been a link as a source of human infection. In addition, the researchers that looked at these online genetic sequences also found now clearer evidence with complete or mostly complete mitochondrial genomes for the raccoon dog, as I noted, but also the Malayan porcupine, the Amur hedgehog, the masked palm civet, and the hoary bamboo rat. These were all located in wildlife stalls where there also was coronavirus found. And in particular, it's of note that not only have we focused on the issue of raccoon dogs, but also we know that masked palm civets have previously been associated with SARS itself, not SARS-CoV-2, but SARS. So this just gives us more evidence to say there. Could have been this combination of animals and virus. And this is really important. This may seem like a long winded way of saying that we know that there were positive COVID 19 samples in the same market stalls that housed raccoon dogs and other possible animal sources and that they were never directly tested for COVID. And a lot of the COVID 19 cases in humans can be traced back to the market. But I would agree completely, there is no bullet proof evidence that what started the transmission was the virus in these animals in the market.


Dr. Osterholm: [00:27:35] So all I can say is at this point, I think the evidence is more supportive of a spillover event and than it was with an actual lab leak. I will continue to obviously be criticized by many who think somehow that's an apology statement for China. It's not. It is not. I don't know why these data were not made available sooner from the Chinese government than three years after the pandemic began. That's terribly unfortunate. Wrong. But the bottom line is, is we'll never have enough data that anyone will believe. If somebody came up with a frozen raccoon dog out of a freezer in a laboratory right now in China and said that was in the market, oh, it's positive for the virus. There'd be many people say, oh, it was all made up. Didn't really happen. So, again, none of this debate is going to help us be better prepared for future pandemics. And I will continue to stay laser focused on that because to me, that is how we'll be judged when the next pandemic emerges, not how well we debated what the source of the COVID 19 pandemic was, but how much did we do to get better prepared based on what we learned or should have learned from our response to the COVID 19 pandemic?


Chris Dall: [00:28:48] Now to the latest in the ongoing controversy over the Cochrane Review on masking. On March 10th, the editor in chief of the Cochrane Library sent a statement to New York Times columnist Zeynep Tufekci saying that the way it summarized the review was unclear and imprecise and that the way some outlets interpret it was wrong. Mike. This whole episode seems to be another bad moment for scientific communication, and we've seen a lot of those moments during the pandemic. Your thoughts?


Dr. Osterholm: [00:29:19] Yes, Chris, I absolutely agree. This is a very bad moment for scientific communication. And it's one of the many that is contributing to what I previously described as a pandemic of lost trust with the public health and medical communities. As you noted, Cochrane released a statement on March 10th, over a month after the review was published, stating that the review was being misinterpreted by commentators. They apologized. They again, let me point out, they apologized for their plain language summary which stated We're uncertain whether wearing masks or N95 P2 respirators helps to slow the spread of respiratory viruses based on studies we assessed. Now, I believe this was a very, very weak attempt at an apology for their very biased, poorly conducted review. And I believe that stating that this is an issue of misinterpretation is simply a stretch. Tom Jefferson, the lead author of this review, was quoted as saying, There is no evidence that masks make any difference, full stop, unquote. How can you not understand that to mean that they were somehow misunderstood? Simply not true. They're covering their south side. And unfortunately, this particular Cochrane review then led to Bret Stephens in The New York Times commenting a few weeks ago, supporting the fact that respiratory protection did not matter. As you mentioned in your question, Chris, The New York Times has since published a piece by Zeynep Tufekci, which we will link in the episode description titled “Here's Why the Science is Clear that Masks Work,” which provides a detailed explanation of all the flaws in the clock and review.


Dr. Osterholm: [00:30:51] Now, ironically, I also want to note that I don't agree with a lot of her conclusions that she made in the article, particularly the implications that a high quality and well fitted mask is only preferred and not required to be adequately protected against COVID. She obviously did not understand the very basics of aerobiology and respiratory protection. This has been a common problem with all these people who are writing critiques about masking, i.e. something in front of your face versus use of respiratory protection based on an N95 respirator. I can't say that enough times. A face cloth covering a cloth mask or a surgical procedure mask are not at all equivalent to an N95 respirator. So I think while the New York Times piece really did, you might say, lay open the inconsistencies and the challenges in the Cochrane Review with some of the statements. Even The New York Times piece was unfortunately not a well-written piece relative to the actual science of this issue. So, yes, we just have to live with the fact that we continue to confuse the public. And all I would come back to and even with me with my infection, I would say again, the best protection you can have is a well fitted N95 respirator. It is not just wearing a something in front of your face kind of world right now. If you're at increased risk for serious illness, hospitalizations or deaths, be fully vaccinated as much as you can get. Number two, in your in settings where you may be exposed in public settings, etcetera, where you're N95.


Dr. Osterholm: [00:32:30] Now, you know, I wore my N95 and a lot of places over the past two months where there surely were infected people. I did not get infected during that time, so please don't use my recent infection where maybe it was the elevator and it was my fault. Don't take that to mean that these are not going to be a very important part of protecting you. And I'm so sorry that so many people in the public have to get whipsawed back and forth by this very poor scientific communication. If there's one lesson we should have learned in this pandemic is scientific communication matters. And it matters how it said, why it said and what are the data to support why you're saying it. And again, I come back to a point that you've heard me say many, many times. We have lacked humility in this pandemic over and over again in terms of understanding what we know and what we don't know, how we know, what we know, what we're trying to do to find out what we don't know, and making certain that we distinguish those as best we can. So I hope we don't have this topic come up any more. I can only imagine, you know, if you keep piling on bad study on bad study or bad comment on bad comment, it doesn't make it any better. You know, bad squared is still bad bad. So we'll hopefully see an end to this discussion and people really beginning to recognize the importance of meaningful and adequate respiratory protection.


Chris Dall: [00:34:00] Now it's time for our COVID query. This week we received an email from Jay who wrote, There seems to be a clinical controversy on when to receive a booster after testing positive for COVID. What is your understanding of how soon to get the Bivalent vaccine after testing positive taking paxlovid and recovering? So, Mike, what can you tell Jay? And while we're on this topic, is there any news on whether or when FDA and CDC might approve an additional booster shot?


Dr. Osterholm: [00:34:31] Well, Chris, this is a great question. Thank you, Jay. And unfortunately, there's not a lot of available data to answer it. The current CDC guidance states that people are only required to wait until the end of their isolation period to get a booster after they've been infected with COVID 19, but may consider waiting three months after the onset of their symptoms to get a booster dose and get the maximum protection from that dose for the first 90 days following infection. There's clearly very little risk of reinfection, so it makes sense to wait at least that long before getting an additional dose of vaccine. Some immunology experts believe that waiting 4 to 6 months may result in a better immune response than a booster dose producing stronger and longer lasting immunity. However, for those who wait six months to get their booster dose, that means they're at greater risk of becoming infected in that time between 90 days following their infection and when they choose to get their booster. For some individuals, depending on their risk for severe disease and the level of exposure they have in their daily lives, this may not be a risk that they're willing to take, but for many of us, and likely for most listeners of this podcast, this is currently not a decision we have to make because we've already received all the booster doses were eligible for. We are not debating whether to get this or another booster at three months or six months after infection because we cannot, at least for the time being.


Dr. Osterholm: [00:35:55] I have shared my frustration regarding this issue several times on this podcast, and several members of the podcast family have reached out to us with similar feelings or frustrations about not being able to get a booster. I've said time and time again we cannot boost our way out of this pandemic. So many people will not accept a booster dose even if available, and I'm sure the majority of the public would disregard any recommendation to get an additional booster dose, considering only 16% have. But I also take a step back. Four and a half weeks before I had my exposure and onset to COVID, I made an attempt to get a second booster. I was very honest about it, made it clear that I'd already received one, and I could not find a pharmacy or a doctor's office who would vaccinate me. They were following the CDC, ACIP recommendation. I think to myself, here I was almost seven months after my original booster dose now wanting to get an additional booster and I was turned down. What would have happened had I gotten my booster four and a half weeks before I got my infection? Might I have been protected? I sure think so. At least not getting clinically ill, but I don't know. So I think at this point, let me just say that there has been some movement this week with regard to the possibility that FDA is considering now allowing permissive language for individuals who are at least six months out, who may be at increased risk for serious illness to get an additional booster dose.


Dr. Osterholm: [00:37:25] In a Wall Street Journal article that was published on March 21st, they actually acknowledged that Food and Drug Administration officials could make a decision within a few weeks to allow this to happen. And they have received lots of pressure to do that. So nobody is saying you have to get it as a recommendation, but more it's a permissive statement saying if at six months and you fit into these high risk categories for serious illness, hospitalizations or deaths, you should be able to get a booster dose. And I think as we've seen in the UK and Canada, they've already begun leaning into this issue with permissive language allowing that to happen. So I think stay tuned. I think you're going to have language soon. And with that I would surely urge people to consider if you're six months out, particularly if you're someone with the potential for serious illness, hospitalizations or deaths, I would urge you to get that booster knowing that it will be a minority of those individuals in this country who could benefit from it, but who basically at this point will not get it under any conditions. So I hope that answers your question. It's a it's a bit complicated, but the bottom line is, is that you now know the timeline 3 to 6 months post previous infection and hopefully you can get the bivalent booster even a second dose in the near future.


Chris Dall: [00:38:51] Mike, do you have any reflections on this third anniversary of the beginning of the pandemic here in the US? And does your recent infection color the way you view this?


Dr. Osterholm: [00:39:04] Chris. You know, my world is so colored by COVID, I feel like I live in a daily kaleidoscope. Some wonderful, wonderful highs, Some very, very painful, very low, low moments. You know, the wonderful highs really relate to what I said earlier about the families and friends aspect of what COVID has done. And, you know, when I mentioned in a previous podcast that we were taking some pretty heavy incoming as it related to comments about China and some of the very ugly, painful and threatening emails, the response from the podcast family was simply, absolutely beyond remarkable. If I had a nickel for every minute that I had tears running down my cheeks reading these incredible emails, I could have taken us all out for dinner in some safe restaurant somewhere. It was remarkable. I've watched the CIDRAP podcast team. I've watched our center in general looking at what we just did with the coronavirus vaccine roadmap.Time and time again, when the tank was empty, they still somehow went another 100 miles. It's remarkable in terms of understanding what friends mean. There are so many people who listen to this podcast who have lost loved ones. They remember every moment of the day that those loved ones were not numbers. They were grandpa and grandmas, moms and dads, aunts and uncles, brothers and sisters, even children. The most painful cut of all. And so I think that from that perspective, after three years, we've learned a lot about pain and suffering. But we've also learned a lot about how to be there for others. So to me, that's what I will take home from this pandemic response of the last three years. I will say for certain, I can't wait till it's over.


Dr. Osterholm: [00:41:00] Over. But I also feel so compelled to say now's not the time to rest. Yes, we've been through a long, long marathon, but we've got to get ready for the next pandemic. Remember, this was not necessarily the big one at all. Think about this. This virus was highly transmissible, highly transmissible, but it killed less than 1% of the people that got infected, which is still a lot of people. And you infect a lot of people. But what happens if we see a SARS or MERS virus scenario where the number of people who die from infection is anywhere from 15 to 35%? And this virus has wings just like SARS-CoV-2. Imagine that. Imagine that. Imagine an influenza virus is like 1918. Imagine that. So I think that one of the things I reflect on is for my kids and my grandkids, I owe it to this world to never let up. Getting better prepared for the next one, too. And as I reflect on these three years, like so many of you, we're tired, we're tired, we're very tired. But now's not the time to allow that to take over. We've got to keep focusing on what can we learn from this experience that will make us better prepared for the future. What can we do to basically make a world more pandemic ready than it ever has been before? That's what I'll think about with your the three years of this pandemic. I will mourn those that we've lost. I will mourn them. But I'll also celebrate the friends, the colleagues, the podcast, family members that we've come to know and love. That's what I'll remember for three years.


Chris Dall: [00:42:50] And speaking of the regular boost that we get from our listeners, what can you tell us about our latest Beautiful Place submission?


Dr. Osterholm: [00:43:00] Well, you know, beauty is something that is often been said to be in the eye of the beholder. And in this case, I think it's also has a corollary that says something about what's in your soul. And as much as we have focused on these wonderfully beautiful scenes that people have shared with us from all over the world, sometimes the most beautiful place is right inside our hearts. This particular beautiful place submission comes from someone who talks more about the beauty of inside and not the rest of the world. And we thought it was fitting in light of the conversation today to share this. This is from Jennifer. Thank you so much, Jennifer. She wrote, Dr. Ostrom, I sit here in the morning of February 9th, my 43rd birthday, reflected on your kind words at the end of your podcast. I want to share with you and your staff how thankful I've been for the podcast during this pandemic. It has brought me the knowledge and comfort I have so craved during the time of uncertainty. You and your team have even inspired me to go back to school and get my BS in public health. My beautiful place has been at home with my family here in Sonoma, California. While wine is inherently a beautiful place to live in. This is not what made it a beautiful place. The pandemic made a stop and focus on what is truly important. My husband changed his career so he could stay at home and focus on Zoom school.


Dr. Osterholm: [00:44:24] For my older son, who was seven years old when this pandemic started and a variety of Zoom therapies for my younger son, who was three years old and has Down syndrome. We have learned to live with less and focus on more quality time together. We bought a bubble machine and have spent countless hours outside running through the bubbles that in turn float around our neighborhood. We have made connections with neighbors and have a wonderful sense of community that probably wouldn't have happened without the circumstances of this pandemic created. While I know this pandemic has taken so much from so many and certainly hasn't been easy for us, my older son is now ten years old and has not had one year of normal, uninterrupted school since preschool. Between fire evacuations and the pandemic. Still, I sit here grateful for all the lessons this experience has taught me and the knowledge that my beautiful place is as simple as watching my boys who are now ten and five, run through the bubbles in the front yard. Sincerely, Jennifer. How can you not feel the beauty of that? Thank you, Jennifer. It is truly a gift to share that. And I know that many others feel exactly the same way you do. Yes, there have been a price to pay, a horrible price to pay with this pandemic, but there have been some gifts and they are beautiful places. And for sharing your beautiful place with us. Thank you so very, very much.


Chris Dall: [00:45:53] And Mike, what are your take home messages for today?


Dr. Osterholm: [00:45:56] First of all, I continue to emphasize how humble I am by this virus. This virus continues to throw curveballs at us. No longer are we seeing 210 mile an hour curve balls, but we hope that that doesn't return. But I think we have to recognize just what we've been through and what this virus has done to us during that time. And the one word I keep coming back to is humility. My second point is how do we define a pandemic? Is it over with? Is this one over with? And yes, it is for many. But for some of us are still not. You know, 225 to 300 deaths a day at the lowest end we've seen in months. That's still a lot of deaths. And so I think it's really important that we understand that, yes, we're not in a big debate about is the pandemic over or not? Some will want to debate that there is still substantial illness, serious illness occurring out here. And so we have to keep asking ourselves, how can we best help protect those individuals who are at highest risk for that and at the same time move on with the pandemic. And finally, when it comes down to understanding what happened in China, I just stick with the point. I don't think we will ever know in a way that will convince the majority of people that it was A or B or C that did it. And while I will welcome any new information that can help inform on that very issue, the challenge we have is keeping focused on getting prepared for the future, whether it's a lab leak or whether it's a spillover. That should be the important take home that we have to keep focusing on.


Chris Dall: [00:47:45] And I think I can guess what it's going to be. But what is our closing song or a poem for us today?


Dr. Osterholm: [00:47:51] Well, Chris, you're pretty darn good at guessing these. You read my mind a lot. I'm using a song today that has actually been used six times before, and that should tell you something about how important I believe it to be. The song is Friends by Elton John and Bernie Taupin. We used it in Episode 54: Vaccines and Taking Care of Friends on May 6th, 2021. We use it in Episode 65. An Ongoing Tug of War in August 19th, 2021. We used it in Episode 81, The Early Data on Omicron, December 9th, 2021, Episode 97: This Virus Isn't Done with Us on March 31st, 2022, Episode 108: Living with COVID, July 8th of 2022, and the most recent was in Episode 144: A Three Act Play on September 29th, 2022. So again, we're going to use it today because I think it's so reflects on the opening comments, the dedication, and really what we all are talking about right now that it's so important to us in our lives. Friends is a song, as I noted, written by English musician Elton John and songwriter Bernie Taupin and performed by Elton John. It was John's third US hit and his second to reach the top 40 after his breakthrough success of your song. The song rose to number 34 on the US Billboard Hot 100 and number 17 on the cash box Top 100.


Dr. Osterholm: [00:49:24] On the Canadian singles chart, Friends peaked at number 13. Friends also became a hit on the adult contemporary charts of both nations. So here it is. It's all about our friends Elton John and Bernie Taupin. I hope the day will be a lighter highway for friends are found in every road. Can you ever think of any better way for the lost and weary travelers to go? Making friends for the world to see. Let the people know you got what you need with a friend at hand. You will see the light if your friends are there. Everything's all right. It seems to me a crime that we should age. These fragile times should never slip us by. A time you never can or shall erase. As friends together, watch their childhood fly. Making friends for the world to see. Let the people know you got what you need. With a friend at hand, you will see the light. If your friends are there, then everything's all right. Making friends through the world to see. Let the people know you got what you need. With a friend at hand, you will see the light. If your friends are there, then everything's all right. Thank you to all of our dear, dear friends on this podcast.


Dr. Osterholm: [00:50:41] Appreciate your participation, your input, your messages, your emails. We read every one of them. And finally, I want to acknowledge that personally, I'm in a bit of a struggle right now with my own COVID case. It's not something that I had ever thought would happen. And yet, as an infectious disease epidemiologist so familiar with this virus, I knew that risk was always there. I never, never took it for granted. So I leave you today knowing that I have a very different appreciation for this virus now than I did at the last podcast and one that makes me even more committed to being there. For all those of you who every day work so hard to avoid getting infected. And for those who have been infected, I understand now in a way that I might not have before of the questions, How did I get it? Why did I get it? You know, did I do something wrong? You know, what's the status? So thank you so much for being with us, remembering that today it's about friends. Also remembering the fact for those who we've lost to COVID, for those who are still suffering from long COVID. Thinking about them as our family and friends. So be kind and be thankful that we're all here. Thank you so much. Thank you.


Chris Dall: [00:52:08] Thanks for listening to this week's episode of the Osterholm Update. If you're enjoying the podcast, please subscribe rate and review and be sure to keep up with the latest COVID 19 news by visiting our website This podcast is supported in part by you, our listeners. If you would like to donate, please go to The Osterholm Update is produced by Cory Anderson, Meredith Arpey, Elise Holmes, Sydney Redepenning and Angela Ulrich